November 17, 2002
IL (AHA) – Survival rates following
emergency angioplasty for heart attack are the same regardless
of the availability of on-site cardiac surgery, according to
research reported at the American Heart Association's Scientific
"This is the
largest study to date demonstrating the benefit of immediate
angioplasty in acute heart attack patients," says lead
researcher Timothy A. Sanborn, M.D., chief of the division of
cardiology at Evanston Northwestern Healthcare, in Evanston,
Data on 30,358
patients eligible for percutaneous coronary intervention (PCI,
also known as angioplasty) at more than 700 hospitals were
collected from the National Registry of Myocardial Infarction (NRMI).
The NRMI is one
of the largest observational studies of acute myocardial
infarction (heart attack). It includes data on more than 1.8
million heart attack patients in the United States.
are significant. Hospitals with diagnostic laboratories that
meet American Heart Association/American College of Cardiology
criteria for performing emergency angioplasty without on-site
surgery should perform these life-saving procedures rather than
transfer patients to another facility with on-site surgery,"
says Sanborn, who is also co-director of Evanston Northwestern’s
Cardiovascular Care Center and a professor of medicine at
examined in-hospital death rates and elapsed time from hospital
door to angioplasty procedure for 1,935 patients at 97
facilities without cardiac surgical units where diagnostic
catheterization or PCI procedures were performed electively. The
data were compared with those for 28,603 patients treated at 562
hospitals performing elective PCI with on-site cardiac surgery
rates were 3.2 percent at facilities with diagnostic
catheterization but no cardiac surgery, 4.4 percent at hospitals
with PCI but no on-site surgery, and 5.0 percent at hospitals
with PCI and on-site cardiac surgery. In the last group, death
rates ranged from 6.5 percent among patients transferred from
another facility to 4.8 percent among patients treated in-house.
elapsed time between patient arrival and angioplasty also varied
significantly, depending on where the procedure was performed
and whether the patient was transferred to a cardiac
catheterization unit at the same hospital or elsewhere. If
transferred from an outside facility, the average heart attack
patient waited about 198 minutes before undergoing PCI, compared
to 107 minutes at hospitals performing PCIs with or without
surgical ability, and 96 minutes at facilities performing
diagnostic catheterization without surgical units.
show that at almost 100 hospitals without on-site surgical
ability, performing emergency PCI is both safe and effective,"
The data suggest
that hospitals providing diagnostic heart catheterization could
save lives by providing immediate emergency balloon angioplasty
for acute heart attack patients, Sanborn says.
delay in providing PCI after a heart attack increases a
patient's risk, selected hospitals with diagnostic
catheterization laboratories should perform them rather than
transfer these patients to another facility with on-site cardiac
surgery," he says.
attack patients elsewhere for angioplasty doubles the delay
before the procedure can be performed, the researchers found.
Heart Association and the American College of Cardiology have
specific guidelines on performing angioplasty during acute
myocardial infarction, and stringent criteria that should be met
for hospitals without cardiac surgery on-site," Sanborn notes.
was no analysis to determine if sicker patients might have been
transferred elsewhere more often, death rates for transferred
patients were more than one-third higher than in patients
treated more rapidly.
He adds that as
emergency angioplasty is performed by more hospitals without
on-site cardiac surgery, a prospective analysis of results using
national databases will be necessary.
include Alice K. Jacobs, M.D.; Paul D. Frederick, M.D.; Nathan
R. Every, M.D.; and William J. French, M.D.